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General NPI Number Information
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NPI Number | 1881215622
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Entity Type | Organization
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Legal Business Name | BRIDGE DIAGNOSTICS LLC
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Dates
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Enumeration Date | 05/04/2020
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 120 VANTIS DR STE 570
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City | ALISO VIEJO
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State | CA
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Zip | 92656-2618
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Country | US
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Telephone | 800-803-1611
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Fax |
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Provider Business Mailing Address
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Address Line | 120 VANTIS DR STE 570
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City | ALISO VIEJO
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State | CA
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Zip | 92656-2618
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Country | US
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Telephone | 800-803-1611
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Fax |
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Authorized Official
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Title or Position | DIRECTOR RCM AND PAYOR RELATIONS
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Name | JOIE LANE
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Credential | CPC, CHC
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Telephone | 678-468-7047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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